"That is 1/16th of what our developing social brain is looking for."

What Happened To You?: Conversations on Trauma, Resilience, and Healing REVIEW

Trauma.

You can fight. You can flee. You can freeze. You can also, it appears, flock or feign. But this book offers a great deal more specific detail about the brain, trauma, neglect, and resilience than I had picked up from previous readings. The book reads like a transcript of an interview between someone who really knows how to interview and someone who really knows their subject. Oprah Winfrey and Dr. Perry left me with a few specific pieces of wisdom that I hope to incorporate into my own (TIC) Trauma Informed Care practices.

First is his concept of sequential development. Human beings develop into fully human members of societies along a sequential route. Before they develop language and reason, they must develop emotionally and relationally. And before they can develop emotionally healthy relationships, they need to develop the ability to regulate and assimilate into internal rhythms. “Rhythm is essential to a healthy body and a healthy mind,” he insists. Of the first weeks and months of life he says, “The roots and trunk of our brain’s tree of regulation are being organized.”

Dr. Perry compares this developmental work to the building of a house.

“Think of it like building a house. The foundation is put in place first, then the framing, then the flooring and wiring and plumbing – all of it before the house can be occupied. As we’ve said before, the brain also develops from the bottom up. The lowest networks, those that make up the CRNs, develop first, starting in the womb, and the functions they mediate and modulate show up first during our development.”

“With a house, if you do a bad job with the foundation, put in shoddy wiring and plumbing but decorate it with beautiful flooring and furniture, the core defects in the house may not be visible at your first walk-through. But these early construction issues will lead to problems later on. The same is true with a young child. Really, every aspect of human functioning is influenced by early developmental experiences – both when they are consistent, predictable, and loving interactions and when there is chaos, threat, unpredictability, or lack of love.”

Because this is so, my second major take-away follows. Because the foundations of the brain’s emotional and relational functioning are vital precursors to that functioning, there is almost nothing better that you can do for a human being’s chances of flourishing than to give them devoted caregivers in the first months and years of life. “Early in life the brain needs consistent, patterned experiences to develop some key systems,” Perry states, and then looks at language development to illustrate what he means.

“Say you speak only English to an infant for six weeks and then say, ‘English is done, we’re going to speak Chinese.’ For the next five months the child hears only Chinese, but then you say, ‘We’re done with Chinese, now we’re going to speak French.’ And the language spoken to the child changes 10 more times before they turn three. This poor child will not speak any language at all. Despite the fact that these are good languages, and that all languages activate the speech and language part of the brain, there were never sufficient repetitions with any one language to properly organize the child’s full speech and language capability.”

In a similar way, a child really needs consistent care more than anything. Lacking it early in life, there are no roundabout ways to deal with future problems than to make every effort to rebuild that regulation with the same sort of consistency that they should have gotten years earlier. It may seem like you are treating such a child in an age inappropriate way but  . . . the fact is, you are not. You are building foundations never built. As Dr. Perry puts it,

“Not only is ‘what happened to you?’ the key question if you want to understand someone, it is the key question if you want to understand the brain. In other words, your personal history – the people and places in your life – influences your brain development. The result is that each of our brains is unique. Our life experiences shape the way key systems in our brain are organized and function. So each of us sees and understands the world in a unique way.”

If a child or adult is not able to form stable healing emotional relationships it may not be that they have chosen not to. It may be that they were rendered incapable of doing so. There is a wicked catch-22 here. You may actually need to be in community in order to maintain a sense of self-regulation and to heal from ‘the stings and arrows of life’s outrageous fortune or to take arms against a sea of troubles’ as Shakespeare would put it. But if you don’t have the foundational structures of self-regulation and security, you may never get the chance to build the healthy human network that you need to do so.

The third take-away I got from this book is just how important the first year of that child’s life is for this work. Dr. Perry levels with the reader about the striking findings of the research.

“Our second major finding is that the timing of adversity makes a huge difference in determining overall risk. Put simply, if you experience trauma at age 2, it will have more impact on your health than the same trauma taking place at age 17."

“When we look a little deeper into the timing of developmental risk, a powerful observation emerges. The basic finding is that the experiences of the first two months of life have a disproportionately important impact on your long-term health and development. This has to do with the remarkably rapid growth of the brain early in life, and the organization of those all- important core regulatory networks.”

“The key to having many healthy relationships in your life is having only a few safe, stable, and nurturing relationships in your first year. This lets you get adequate repetitions to build the foundation – the fundamental relational architecture – it will allow you to continue to grow healthy relational connections.”

The fourth take-away I would like to mention is Dr. Perry’s insistence that you cannot solve a regulation problem with rationality. Working with abused or neglected people requires that you start from what Dr. Perry calls “the bottom up.”

“All experience is processed from the bottom up, meaning, to get to the top, ‘smart’ part of our brain, we have to go through the lower, ‘not-so-smart’ part. The sequential processing means that the most primitive, reactive part of our brain is the first part to interpret and act on the information coming in from our senses. Bottom line: our brain is organized to act and feel before we think. This is also how our brain develops - sequentially, from the bottom up. The developing infant acts and feels, and these actions and feelings help organize how they will begin to think.”

And thus, if a child is having a fit, one cannot reason the child out of said fit until you hold them and rock them and sing to them and put them back into those coveted rhythms of a regulated state of peace. One of the things I appreciate about Dr. Perry’s approach is how open he is to what anthropologists have to teach us about the mental health wisdom of indigenous people. There is a reason why they gathered (or gather) in small tribal groups and told stories and listened to drumming and sang and danced and banded together into community. His argument seems hard to contest. If someone is acting out because they are dysregulated and dis-connected from relationship, it hardly seems wise to try and convince them with rational arguments, to act as if they were regulated and connected.

“Anything sequential happens in a sequence, a set of steps – first a, then b, then c. And as we said, the way our brain processes our experiences is sequential. All sensory input (physical sensations, smells, taste, sight, sound) is first processed in the lower areas of the brain; the lower brain gets first dibs. This means that before any new experience has a chance to be considered by the higher, thinking part of the brain, the lower brain has already interpreted and responded to it. It’s matched the sensory input from the new experience against the catalog of stored memories of past experiences – before the smart part of your brain even has a chance to get involved."

"If someone is stressed, angry, frustrated, or otherwise dysregulated, the incoming input will be short circuited, leading to inefficient, distorted input to the cortex. This is where the sequence of engagement comes in. Without some degree of regulation, it is difficult to connect with another person, and without connection, there is minimal reasoning. Regulate, relate, then reason. Trying to reason with someone before they are regulated won’t work and indeed will only increase frustration for both of you.”

“It is very difficult to meaningfully connect with or to get through to someone who is not regulated. And it is nearly impossible to reason with them. This is why telling someone who is dysregulated to ‘calm down’ never works.”

Give them rhythms. Give them connection. Then start the conversation when they indicate that they are ready to do so. “It comes back to dysregulation,” he writes,

“There is always a pull to regulate, to seek comfort, to fill that reward bucket. But it turns out that the most powerful form of reward is relational. Positive interactions with people are rewarding and regulating. Without connection to people who care for you, spend time with you, support you, it is almost impossible to step away from any form of unhealthy reward and regulation. This includes alcohol overuse, drug overuse, eating too much sweet and salty food, porn, cutting, or spending hours and hours on video games. Connectedness counters the pool of addictive behaviors. it is the key.”

Medications can make regulation and connectedness more possible, but they can never substitute for that connectedness. “Neglect is as toxic as trauma,” he says.  This leads to my fifth take-away.

Mental health is generally a ratio between your traumas and your supportive networks. What is sad is that, as a general rule, the more vulnerable you are to trauma in life, the less likely you are to have a robust assortment of supportive members of a team to help you deal with it. Generally, the same sort of health of community that protects a child from trauma helps that child to repair the damage done by that trauma. Dr. Perry writes,

“Our major finding is that your history of relational health – your connectedness to family, community, and culture – is more predictive of your mental health than your history of adversity. This is similar to the findings of other researchers looking at the power of positive relationships on mental health. Connectedness has the power to counterbalance adversity.”

Lacking healthy regulation and connection, children, and the adults that those children grow into, reach for alternatives.

My sixth take-away from this book has to do with what Dr. Perry refers to as “therapeutic doses.” By this, he does not mean the scheduling of more sessions with a therapist (although that might help). It has to do with bringing therapeutic “healing” moments into the interactions of daily life. It means realizing that everyone in a person’s life can play a role in “re-nurturing” others who have been neglected or traumatized. We can all make efforts to help other stay regulated and connected. No one recovers from these things in two or three therapeutic sessions. We give and receive these doses of nurture in the course of healthy community.

“When you have friends, family, and other healthy people in your life, you have a natural healing environment. We feel best in creating a network - a village, whatever you want to call it – gives you opportunities to revisit trauma and moderate in controllable doses.”

When referring to “controllable doses” Perry is reminding us that people need to be able to tell us when they are ready to move into any sort of cognitive conversation about their traumas. What is so unfortunate is that the neglected or abused brain is likely to call down upon itself exactly what it does not need. Children will adapt to trauma and neglect in ways that will not serve their own healing interests unfortunately. Perry puts it this way:

“What is adaptive for children living in chaotic, violent, trauma permeated environment becomes maladaptive in other environments – especially school. The hyper vigilance of the alert state is mistaken for ADHD; the resistance and defiance of alarm and fear get labeled as oppositional defiant disorder; flight behavior gets them suspended from school; fight behavior gets them charged with assault. The pervasive misunderstanding of trauma related behavior has a profound effect on our educational, mental health, and juvenile justice systems.”

Alas, when a child’s lack of regulation and connection leads to an inability to respond to reasonable requests for socially sophisticated behavior, the child is likely to provoke an excommunication from the very regulation and connection they need. In essence, you get punished and isolated for being abused and neglected. No one asks “What happened to you?” They ask “What is wrong with you?” And so, the cycle continues.

“In our work, we find that the best predictor of your current mental health is your current relational health, or connectedness. Disconnectedness is fueled by two things: the basic capabilities you’ve developed to form and maintain relationships, and the relational opportunities you have in your family, neighborhood, school, and so forth.”

The writer and bio chemist Isaac Asimov said, “the saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.”

My seventh take-away relates to just what constitutes trauma in our lives. Dr. Perry uses the “Three E’s” definition of trauma, which suggests that trauma has three key aspects - the event, the experience, and the effects. “The complexities of these three inter-related components are what should be considered in clinical work and studied in research,” he says. To understand a child or an adult who has yet to deal with their trauma in life, one needs to ask “What happened to you?” rather than “What is wrong with you?” One has to know what happened to them, how they experienced what happened to them (how did they cope or try to cope), and what present impact upon their development resulted.   

My final take-away from this exploration of trauma has some pessimism and optimism in it. The book left me thinking that we are, as a human community, a bit more screwed than I had thought we were. The world is full of traumatized and neglected people. But I was also left with a sense of optimism as well. We know what we need to do now. There is a path forward. But that path does not involve continuing down the road we have been on. Two paths diverge in a wood and the one that will get us out of these dark woods is the one that requires a more intelligent sort of caring than we have been capable of thus far. Dr. Perry’s words struck me as somewhat prophetic:  

“No other society in the history of this planet has ever asked a single adult to provide the physical, social, emotional, and material needs of multiple children by themselves. … We are meant to distribute the caregiving among the many adults in our band – our community. In a typical hunter gatherer clan, for every child under six there were four developmentally more mature individuals who could model, discipline, nurture, and instruct a child. That is a 4 to 1 ratio: four developmentally mature individuals for each child under six. We now think that one caregiver for four young children is “enriched.” That is 1/16th of what our developing social brain is looking for. That is relational poverty.”

Time to redirect some resources.

Question for Comment: What part do you play in the prevention of trauma and neglect or the healing of the same. Is there any world in which this role can be completely delegated to others or must we all play a part?